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Drinking Tea ‘Reduces Stroke Risk’

Here’s some good news for tea-lovers: having three or more cups of the drink everyday can cut the risk of stroke, says a new study.

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According to Lenore Arab, professor of medicine at the David Geffen School of Medicine, drinking the beverage can reduce the threat by as much as 21%.

UCLA boffins observed that the result was obtained in tea made from the plant Camellia sinensis and not from herbs. It was contemplated that anti-oxidant epigallocatechin gallate or the amino acid Theanine in teas may be what leads to the reduced risks.

“By drinking three cups of tea a day, the risk of a stroke was reduced 21%,” the New York Daily News quoted Arab as saying. “That’s why these findings are so exciting. If we can find a way to prevent the stroke, or prevent the damage, that is simple and not toxic, that would be a great advance,” he added.

Sources: The Times Of India

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CT Scan Scores Over Angiography

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A reports on a study that highlights the safety issues involved in detecting coronary blockages:-

Noninvasive CT scans are nearly as accurate at imaging coronary artery blockages as conventional angiography and are much safer for many patients, according to researchers who published a study released recently in the New England Journal of Medicine.

A CT scanner could eliminate the risks involved with traditional angiograms

.Angiograms are considered the gold standard for detecting blockages. But the procedure involves inserting a guide wire and catheter into the groin, threading them through the blood vessels to the heart and injecting a dye that allows the blockage to be seen in an X-ray.

Using a CT machine instead to make a three-dimensional image of the heart could eliminate the risks involved with traditional angiograms, including heavy bleeding, damage to blood vessels and even death, said Dr. Julie Miller, an interventional cardiologist at Johns Hopkins University School of Medicine in Baltimore and lead author of the study.

More than 1.2 million patients in the US undergo cardiac catheterisations each year, and 1-2 per cent of those cases result in complications, according to the American Heart Association. The National Center for Health Statistics at the Centers for Disease Control and Prevention estimates that about 25 people die each year as a result.

About 20 per cent to 30 per cent of those tests give patients a clean bill of health, and that means that hundreds of thousands of people are exposed to needless risk, Miller said. Many cardiologists see CT scans as a safer alternative because the scans are powerful enough to create a high-resolution image even when the contrast dye is administered by a simple intravenous line and thus more dilute.

Miller and her colleagues at nine hospitals in the US, Canada, Germany, Japan, Brazil, Singapore and the Netherlands identified 291 patients with symptoms of coronary artery disease who were candidates for traditional angiograms. Their median age was 59, and 74 per cent were men.

Before the patients had their angiograms, their hearts were imaged in 8.5 seconds with a 64-slice CT scanner made by Toshiba Medical Systems, which funded the study along with the National Institutes of Health and private foundations.

Two physicians examined each image and graded the degree of narrowing in 19 places in the main coronary arteries. Then the researchers compared the results from both procedures.

In the 163 patients with the highest degree of coronary artery disease — a narrowing of at least 50 per cent in at least one artery — the CT angiograms were 93 per cent as good as traditional angiograms, according to the study. Overall, the CT scans accurately identified 85 per cent of the patients who had the biggest blockages and 90 per cent of the patients who did not.

The researchers also found that 91 per cent of patients who were identified by the CT scans as having the most severe disease were correctly diagnosed, as were 83 per cent of patients whose scans did not reveal large blockages.

Two of the patients in the study had a reaction to the contrast dye used to perform the CT angiogram, and one patient died as a result of the conventional angiogram.

Dr. Matthew Budoff, director of cardiac CT at Harbor-UCLA Medical Center in Torrance, California, said the study confirmed results from his own research using a similar scanner made by General Electric Co. His study, funded by GE, was published this month in the Journal of the American College of Cardiology.

“It’s not quite but almost as good as an invasive angiogram,” said Budoff, who also receives speaking fees from GE. The CT test is faster and costs thousands of dollars less, and patients leave “with a Band-Aid and a bottle of water.”

“The benefits for many patients outweigh the risk of missing 1 per cent of disease,” he said.

But other doctors say that more data are needed to prove that CT angiograms are worthwhile, especially as a screening tool.

“What we really need is a study that compares cardiac CT to traditional ways of working up chest pain, like stress testing, and look at patient outcomes in both groups,” said Dr Rita Redberg, director of women’s cardiovascular services at University of California, San Francisco, Medical Center, who co-wrote a perspective article accompanying the study. “Without actual outcome data, we don’t know that this is going to help patients at all.”

Sources:Los Angeles Times

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Fighting Melanoma in the Mirror

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Skin self-exams are the most direct method for detecting potentially deadly melanoma, though the benefits remain unproved. Moles that are smaller than a pencil eraser are rarely cancerous.

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90 percent of melanoma growths are curable if caught early and removed; untreated, survival rates are worse than for lung cancer. When it comes to melanoma, vanity may be a virtue. The most direct method for detecting this deadly skin cancer is to face a mirror, clothes off, and check for suspicious moles from head to toe.

Melanoma is the biggest no-brainer for screening,” said Myles Cockburn, a preventive medicine expert at the University of Southern California. “You’re looking right at the tumor.”

Moles at least the size of a pencil eraser are of greatest concern, since smaller spots are rarely cancerous, said Dr. David Polsky, a dermatologist at New York University School of Medicine. “To get hung up on the real small stuff is missing the bigger picture,” he said.

But changes to the color, size or shape of any mole may be an early indication of trouble, especially for someone who has a family history of melanoma or lots of unusual moles.

And while sun-drenched areas on the head or legs are likely sites for other forms of skin cancer, melanoma can develop anywhere on the body.

About 90 percent of melanoma growths are curable if caught early and surgically removed, putting the impetus on people at home to look for cancerous spots. When growths are left unchecked, the chances of surviving the disease for long are worse than for lung or colon cancer.

But in the push to make everyone better skin cancer detectives, tough obstacles — and questions — remain.

To locate the first signs of danger requires studious attention, and few people seem willing to bother. Nine to 18 percent of Americans regularly examine their own skin for melanoma, surveys show. Dermatologists, typically the first responders for skin cancer, may be quicker to schedule a Botox appointment than to verify a patient’s concern about changing moles, research shows.

Furthermore, there is no proof so far that such screening will ultimately help save any of the estimated 8,400 lives lost to melanoma each year in the United States.

“It’s still an open question,” said Dr. Marianne Berwick, a melanoma specialist at the University of New Mexico who led the largest and most rigorous investigation so far on skin self-exams. That study found that fastidious skin watchers had no better chance of surviving cancer after five years than those who did not check for moles. Two decades of follow-up have failed to show any improvement, she said.

The stakes are high. The chance of surviving melanoma turns sharply for the worse once the tumors have spread beyond their original site on the skin, making it critical to find changes early.

“There’s no really good proven therapy for advanced disease,” said Dr. Martin Weinstock, a professor of dermatology at Brown University Medical School.

Researchers have tested various treatments, including chemotherapy, radiation and the drug interferon, which show only modest effects against the later stages of melanoma. Newer drugs and vaccines are undergoing testing now. But the main reasons that melanoma survival rates have improved at all over the past 30 years are earlier detection and better screening.

Yet in the rush to get the cancer out fast, experts say they are noticing a relaxing of standards in diagnosing melanoma. Doctors these days are more likely to take out any suspicious mole out of fear of missing a cancerous one, and possibly getting sued for a missed diagnosis, these experts say.

A separate study conducted by Dr. Berwick found that 40 percent of the melanomas detected in 1988 would not have been considered cancerous 10 years earlier.

This could mean that surgeons are removing a fair share of lesions that aren’t melanoma, though even pathologists examining the same skin biopsy samples often disagree on whether the diagnosis is melanoma. At the same time, doctors who aren’t trained in spotting may be leaving harder-to-detect, slow-growing tumors behind.

“Unless you’re specifically trained as a clinician to do a skin exam, you can’t necessarily do a good one,” said Dr. Cockburn of U.S.C.

Nonetheless, like many doctors, Dr. Cockburn still believes that the odds can improve by teaching “your average Joe” to look for melanoma spots, a view shared by the American Cancer Society and other medical groups.

Enlisting the help of a spouse or partner may make it easier to track evolving moles on the body. A camera may also help. One study found that people who took photos of their skin improved their chances of detecting possible melanomas by 12 percent.

The only downside to home screening is in creating a nation of skin cancer hypochondriacs who further tilt the balance to unnecessary operations, experts warn.

But in this age of plastic surgery, the chance to overcome a deadly, but treatable, cancer is worth the risk, Dr. Cockburn said. “With the amount of stuff that gets chopped off these days,” he said, “I don’t really think there’s a problem.”

Sources:
The New York Times:Oct.19.’08

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A Viral Illness That Can Be Silent and Hard to Treat but Also Cured

Hepatitis C can take decades to show up as damage to the liver.

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Chronic viral hepatitis is now the leading reason for liver transplants.

Current combination therapy can be individualized to cure chronic infections in 40 to 80 percent of cases.

The consequences of being infected with hepatitis C can take years to appear. So while new cases of the disease have fallen sharply over the past few decades, many people infected years ago are only beginning to learn they carry the virus, and to grapple with its potentially serious effects.

For many, there is good news. Half of all chronic infections can now be cured through a therapy using a combination of drugs. But hepatitis C remains a wily virus, often lying low for years and then following a course so unpredictable that doctors sometimes aren’t sure whether to recommend treatment or advise patients to watch and wait.

The biggest obstacle to effective treatment remains the fact that a majority of the estimated 3.2 million Americans who harbor chronic hepatitis C aren’t even aware they have it. In four out of five people, there are no symptoms when the infection first occurs.

“Most of the people we see discovered they have chronic hepatitis C when they went to donate blood or had a physical exam in order to get insurance,” said Dr. Bruce R. Bacon, director of the division of gastroenterology and hepatology at Saint Louis University School of Medicine.

Almost a third of those exposed to hepatitis C recover fully; their immune systems rout the virus and eliminate it. About 70 percent develop chronic infections, which carry a significant risk of cirrhosis, or scarring, of the liver and liver cancer. Paradoxically, people who become sickest soon after being infected are most likely to fight off the virus, whereas those who have few if any initial symptoms are at greatest danger of suffering persistent infection.

The treatment currently recommended for chronic hepatitis C combines ribavirin, an antiviral drug, with interferon, a substance that increases the immune system’s virus-killing power. The treatment offers a lifelong cure for more than half of patients. But because the drugs are expensive and can have serious side effects, and because the course of disease varies so much from person to person, the decision to start therapy poses tough questions.

“About one-third of people with chronic hepatitis will go on to develop cirrhosis of the liver,” said Dr. Jay H. Hoofnagle, director of the Liver Disease Research Branch at the National Institutes of Health. “Only 5 to 10 percent will develop liver cancer. In other words, many people can live perfectly well with chronic hepatitis infection and never have any problems. The trouble is we can’t tell who will do well and who will die of the disease.”

Nor can doctors predict with certainty how patients will respond to the combination therapy. In 25 to 30 percent of patients, interferon produces anxiety and depression, sometimes so extreme that sufferers have attempted suicide. It can also cause debilitating flu-like symptoms.

“I can usually get anyone through two or three months of interferon and ribavirin. Beyond that, it gets really tough,” Dr. Hoofnagle said. “At least 10 percent of patients can’t make it through the recommended course of therapy.”

Fortunately, physicians are getting better at optimizing the benefits and controlling some of the unwanted side effects, thanks in part to new insights into the virus. Researchers have discovered that hepatitis C occurs in at least six forms, called genotypes. Genotype 1 is the most common and also the hardest to treat, requiring 48 weeks of treatment. Only about 40 percent of people with this subtype get rid of the virus. Genotypes 2 and 3 can be successfully treated in just 24 weeks, eliminating the virus in about 80 percent of cases.

The more rapidly virus levels begin to fall in patients, the better the odds of a cure. By monitoring levels of the virus in blood, some doctors say, it’s now possible to individualize the course of treatment.

“I call it the accordion effect,” said Dr. Ira Jacobsen, chief of the division of gastroenterology and hepatology at Weill Cornell Medical College in New York. “If virus levels drop off very quickly, we can shorten the course of therapy. If the response is slow, we can lengthen it, sometimes to as much as 72 weeks, and improve the chances of success.”

Shortening the course of therapy remains controversial because of the risk of relapse after the treatment is stopped. Relapse occurs when lingering viruses not eradicated by the medication multiply and surge back.

Antidepressant drugs, meanwhile, are being employed to ease psychiatric side effects. And doctors are getting better at predicting who will suffer depression after starting interferon.

“Not surprisingly, people with a history of depression are at greater risk,” said Dr. Francis Lotrich, assistant professor of psychiatry at the University of Pittsburgh. He and his colleagues have also observed that people with chronic sleep problems are also more likely to have trouble with depression. The reason is not clear, but studies are under way to see if improving people’s sleep with the use of insomnia medication or other techniques can lower the risk of psychiatric side effects.

The best medicine is prevention, and it’s here that the biggest gains have been won against hepatitis C. The number of new infections per year in the United States has plummeted from 240,000 in the 1980s to about 19,000 in 2006. Experts credit a screening test that now prevents hepatitis C from spreading via blood transfusions and organ transplantation, as well as public health messages aimed at discouraging the use of shared needles, which is the leading route of transmission.

In the absence of an effective vaccine, such messages, backed up by intensified surveillance, will remain the chief defense against this virus. In 2003, chronic hepatitis B and C became notifiable diseases that must be reported to federal health officials, enabling them to track new cases nationwide. In 2004, New York State began its own enhanced viral hepatitis surveillance network.

Two years ago, the program demonstrated its usefulness when officials in the Erie County Department of Health detected a cluster of cases centered in one zip code in suburban Buffalo.

“All we had at first was a bunch of dots on a map,” said Dr. Anthony J. Billittier IV, the Erie County health commissioner. Investigators went into the community and identified about 20 young people who were injecting drugs and sometimes sharing needles. The county responded by intensifying prevention efforts, including a free needle exchange.

“We’ve made a lot of progress against hepatitis C, but there’s still a lot to do,” Dr. Billittier said. “One one thing we know about this virus is it’s not going away.”

Sources: The New York Times

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Exercise is the Heart’s Fountain of Youth

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Older people who do endurance exercise training end up with metabolically younger hearts, according to a study at Washington University School of Medicine in St. Louis. By at least one metabolic measure, women benefit more than men from the training.

Researchers measured heart metabolism in sedentary older people both at rest and during administration of dobutamine, a drug that makes the heart race as if a person were exercising vigorously. At the start of the study, they found that the hearts of the study subjects didn’t increase their uptake of glucose in response to the dobutamine.

But after endurance exercise training involving walking, running or cycling exercises three to five days a week for about an hour per session, the participants’ hearts doubled their glucose uptake during high-energy demand, just as younger hearts do.

If heart muscle doesn’t take in glucose in response to increased energy needs, it goes into an energy-deprived state, which can raise the risk of heart attack. But if it can increase glucose uptake, the heart is better protected against heart attack and ischemia (low oxygen).
Sources:
Science Daily July 24, 2008
American Journal of Physiology — Heart and Circulatory Physiology June 20, 2008

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